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13100053CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10676 AMULET PL CONTRACTOR: HOME REMODELERS PERMIT NO: 13100053 DESIGN & BUILD INC OWNER'S NAME: RAO PADAKANDLA K AND YADGIRKAR HEMA 420 JONATHON RIDGE DR DATE ISSUED: 10/07/2013 OWNER'S PHONE: 4089338830 DANVILLE, CA 94506 PHONE NO: (925) 989-6470 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL EI License Class_ Lic. # 7 7 �tO E ADD 12 SQ FT OF BACK SPACE PATIO TO EXTEND KITCHEN ate_/ 'i 7—,/2 Contractor B© —Date/J2_ I hereby affirm that 41am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $4500 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number 32643060.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I i that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHINAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYN FROM LAST CALLED INSP TON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the j G granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. V RE -ROOFS: Signature 7���i ;`� Date l �3 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business &Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent•Dater permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records, granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION o0 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • building(a cupertino.or4 6 ❑ NEW CONSTRUCTION [:1ADDITION ❑ ALTERATION / TI ElREVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS � ® 6 APN # C) (p OWNER NAME 1 PHONE Kr a E-MAIL t � k o STREET ADDRESS CIA, STATE ZIPFAX A 7t CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑OWNER-BUII-DER ❑ OWNER AGENT ❑ CONTRACTOR El CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER 11 TENANT CONTRACTOR NAME &ICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNRME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK � 1 w. EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EX[STG NEW FLOOR DEMO - TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH t #DWELLING UMTS: IS A SECOND UNrr [I YES SECOND STORY []YES " I BEING ADDED? []NO ADDITION? ❑ PRE -APPLICATION- []YES IF YES, PROVIDE COPY OF PLANNING APPL # E] NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES EICHLER HOME? ❑ NO ��. I)TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or author + gent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Wor verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to 'ding const ction.. uthorize representatives of Cup ino toenter the above -identified property for inspection purposes. Signature of ApplicanUAgent: Date: SUPPLEMENTAL INFO ATION REQUIRED x �' OU ING,SL$P�s��s�'s:, „ .,e• New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of builpg�^ permit for new building. ,: �; `_ : S - ��� ���;�,•' _Commercial Bldgs: Provide. a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.- ^!� _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. �21)�STRI � NVll2019ME BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION im,ADDRESS: 10676 amulet pi DATE: REVIEWED BY: PC FEE ID APN: I BP#: `VALUATION: 1$4,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? Yes No OTC. ® Yes ®No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK add 12 sq ft of back sp ace patio to extend kitchen SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 km $0.00 $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ® Yes Q No $0.00 Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 0 $0.001 01 $0 00 NOTE: This estimate does not include fees due to other Departments (i. a Planning, Public Works, tire, Sanitary Sewer District, Sct:oot District. etc). These fees are based on the nreliminary information available and are only an estimate. Contact the Deptfor addn'I info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ® Yes (j) No $0.00 1 hours Plan Check, Hourly $139.00 ISTPLNCK Suppl. PC Fee: Q Reg. Q OT km hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ® Yes Q No $0.00 Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consiruction Tax: rlrlininistrative Fees: 0 Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure i Travel Documentation Cees: Strong Motion Fee: 1BSEISAHCR $0.50 2.0 hrs Inspections $278.001STINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.00 i 5 $1.50 $417.00 $418.50 Revised: 10/01/2013 CUPERTINO PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.or4 PROJECT ADDRESS D w ,_,r G APN # r� OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX C- 9so� APL= N E PHONE E-MAIL s- 1/ a �Ir STREET ADDRESS CITY, STATE, ZIP FAX t zi;t 10 T-0 "TAM 91;4110 D'*j QQ 1% - I ❑ OWNER ❑ OWNER-BUH,DER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT DESCRIPTION OF WORK T.. op EXISTING USE(S): PROPOSED USE(S): t OCCUPANCY(S): TYPE OFt p PARCEL CONSTRUCTION: W AREA: FIRE y WUI AREA: Y ® FLOOD AREA: Y N SIESMIC AREA: Y N SPRINKLERS: Existing Proposed Floor Area: First Floor: s.f. a s.f. COMaJNITYigin-P s.f. s.f. 8I&PAYl0 DIVISION - CUPERTINO S.f. s.f. ToAPPROVED s.f. s.f. This set of plans and specifications MUST be kept at the , ^ � CUPERTINO Job site durin cgr}�ru t�on� j$ �s u I wful to make an Are there�Qdli�i�rY�'drt's'�fi,°sHjnsic�e the garage?8�#fft�Ft# therefrom, without approval from the Building Official. Is privacy protection glancing required for the project? N" ' Th*>perr g of this plan and specifications SHALT_ NOT �� Goverof si1� bnlh '�$ i$ t�'$'ol TRS donthe200y Tn ei�Ait 1F1 &Qi1/IpLIANCE 26 � ftf&n1*599 ka�i55t �"ased on the 2009 IrMp4 ��1 esid n ' a e)'y2010 California Plumbing Code based on the 2009 Uniform Plum ing o ' ' D,ITE 2010 California Mechanical Code (based on the 2009 Uniform Mechanical Code) PIE ?',A T N i orma ec ca o e (base on the 2009 International Electrical Code) 2010 California Green Building Standards Code a , -- . Cupertino Municipal Code V '(OFfl�mlC=h L`;Op�� l ProjectData-ResidentiaLdoc revised 03109/11 C 14 OCT •.4 11 be hei 01 an lk<n COMMUNITY DEVELOPM1PERTINO DEPARTMENT BUILDING DIVISION APPR0\1f D > ns MUST be kept at rm eor,�stru on. It s lawful to make z ges or aft Ar ti son ag, or to deviate m th Building Offici npin f this pt and s ecifi s SHALL t d to rmit or be an a pro a of the vioiatic y provisions o any i rdirnce or State Lai BY �.......� DATE PERMIT NO. W I. 1 10 By( I f3 I PLANNIIlt `DEPT{ •� /DATE \ / RTS`�OFf ICE �I�EP9': i bE 6LI- I}01, 777 u For u - Z - ► sw ��r,� # vA ote r cci,la,; vt e.4- X,,'g & i1} ek (010,1©ifjrAer' O �()C k 1_,, - (E)d =s+; 00k'4- l�.v , o C�a�ba�e e � isPosa,� ��v tfrrt � 8 c It ®r, I . I. 11 be hei 01 an lk<n COMMUNITY DEVELOPM1PERTINO DEPARTMENT BUILDING DIVISION APPR0\1f D > ns MUST be kept at rm eor,�stru on. It s lawful to make z ges or aft Ar ti son ag, or to deviate m th Building Offici npin f this pt and s ecifi s SHALL t d to rmit or be an a pro a of the vioiatic y provisions o any i rdirnce or State Lai BY �.......� DATE PERMIT NO. W I. 1 10 By( I f3 I PLANNIIlt `DEPT{ •� /DATE \ / RTS`�OFf ICE �I�EP9': i bE 6LI- I}01, 777 u For u - Z - ► sw ��r,� # vA ote r cci,la,; vt e.4- X,,'g & i1} ek (010,1©ifjrAer' O �()C k 1_,, - (E)d =s+; 00k'4- l�.v , o C�a�ba�e e � isPosa,� ��v tfrrt � 8 c It Bl� _ a� �£6 -- — — b UL CO cn Z E mlw U LO tB — E— — Q W ry —� 88Z a Q OQ m _ w ) 00 a� w w [r p l' W :3 m as L ui0E— pppz/ -s0�— usg� 00 u� O 0 L ,5 LE A m 7s' Reviewed By: �o��� l4�tulets�/aeeC'U,o=eJ-�,yo 95 �1 I Ba' CUPERTINO Building Department REVIEWEDFO I R �CD B I ,a E= CUNRTINO RT uiIdin g epartment Ex��twc� 4latm Oad - 0.0